Hip pain in children with normal radiographs

Pravin Pandurang Padalkar, Benjamine Tow, Kevin Lim

2.546637

Abstract

Abstract:

Introduction:An acutely painful hip in a child can be the presenting symptom in a number of conditions. One of the most important conditions of which is septic arthritis of the hip for which early diagnosis and treatment is essential. The focus of management in acute hip pain in a child is to rule out septic arthritis as the penalty for missing a diagnosis of septic arthritis of the hip in a child has serious consequences .The purpose of our study is to add to the available pool of data on hip pain, validate the predictive values published by preceding authors. We also hope that by presenting the breadth and scope of patients presenting with an acutely painful hip with normal radiographs, we can assist the physician in decision-making when confronted with this common diagnostic challenge.

Methods: Retrospective review of all the patients who were admitted to our tertiary referral pediatric hospital with complains of hip pain and pain referable to the hip between January 1997 and December 2003. A total of 207 patients 162 patients with normal x-ray were reviewed retrospectively with evaluation of history, physical examination, laboratory studies. Patients whose diagnoses were defined as transient synovitis were made by the attending physician based on result of a combination of some or all of the Laboratory tests.( presence of fever, full blood count, Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) levels, negative blood culture, and effusion on ultrasound, and clinical picture of early resolution. Patients whose diagnoses were defined as septic arthritis or probable septic arthritis were made based on the findings of elevated ESR, CRP, positive blood culture or hip aspiration culture.

Results: The 162 patients included 42 females and 120 males, with an age range from 6 months to 14 years. Of our cohort of patients admitted for hip pain, 111 patients were diagnosed as transient synovitis. 56 patients who were diagnosed as transient synovitis underwent ultrasound examination of the affected hip. 89.3% (50/56) had an effusion with a mean joint space thickness of 6.6mm. 10.7% (6/56) of the patients who underwent ultrasound examination had no demonstrable effusion.

Conclusions: In patients with septic with hip pain and normal radiograph, the commonest diagnosis was transient synovitis comprising 67.9% of patients.Septic arthritis is the most important diagnosis to exclude and should be suspected if there is fever, inability weight bear and highly elevated levels of ESR and CRP needed